It's a Monday morning at Engleburg Elementary School, and every two to five minutes, a child appears at the door to Linda Stone's office.

One has a headache. One got sprayed in the eye with his own deodorant. One sits down to prick his finger and calculate his blood sugar.

"These children need us," said Stone, a registered nurse, before heading out to administer pre-lunchtime medications.

But Stone and 20 other school nurses won't be in Milwaukee Public Schools next year if the district's proposed budget is approved June 7 and left unmodified this fall. Gov. Scott Walker eliminated a $1.5 million state grant in the state biennial budget that supported the 21 full-time nurse positions, and the Milwaukee School Board has not proposed bringing back those positions with district funds.

The disappearing school nurse is not solely an MPS problem - districts elsewhere have sliced school nursing positions to save money - but it's concerning to some because the largely low-income and minority students have serious health issues, such as high rates of asthma and diabetes. Generally, the children have less access to quality health care than their higher-income peers, which makes access to a health care professional in the school all that much more important, supporters say.

Ann Riojas, nurse supervisor in MPS and the president of the Wisconsin Association of School Nurses, said the rise in diabetes among MPS children is one reason the need for nurses has increased. In 2001, MPS had 21 students out of about 100,000 enrolled who needed lunchtime care for diabetes, Riojas said. Today the district has 110 students out of about 86,000 who need lunchtime care for diabetes.

"Some are as young as K-3," she added.

Nurses also tend to free up teachers and administrators from handling student health issues, according to recent research. A study in MPS led by Mary Jo Baisch, assistant professor at the University of Wisconsin-Milwaukee's College of Nursing, showed that principals in a sample of schools that were assigned nurses reported a decrease of about an hour of time each day dealing with student health issues, compared with before they had a nurse.

Clerical staff at schools that received nurses reported a decrease of about 45 minutes a day dealing with student health problems; teachers reported a decrease of about 20 minutes a day spent on those issues.

Students at schools with nurses also had more complete and accurate electronic health records compared with students at schools without nurses, according to the study, published this year in the Journal of School Health.

"These records follow students, even as students travel to schools without a nurse, informing staff in the new school about relevant student health concerns," the study said.

MPS Superintendent Gregory Thornton has said that the potential loss of daily access to nurses for 21,000 students in the district next year "is not a good standard of care for our children."

Nor is having one nurse hop to four or five different schools in a single school day, he said. But the district never funded those nurse positions in the first place, which makes it even more difficult to carve out money from elsewhere in the budget to save the jobs.

Stone, 51, spends her time shifting between Engleburg and Park View elementary schools. Injuries that require explicit medical knowledge are a small part of her work. She spends much of her time following up with parents and grandparents and aunts and uncles to decipher what's going on with a student in distress.

Last week a boy showed up at her door who wouldn't talk, so she made phone calls, hit dead ends because numbers had changed, and then updated as much contact information as she could when she finally got a relative on the line to talk about the child.

Managing medications is another matter. Three white plastic tubs in Stone's office sit stuffed with midsize manila envelopes for each student who needs meds. Stone carefully counts out each pill before logging the child's medications in the manila folder. When their pills don't get refilled, or come in a bottle with the label torn off, or don't last until the end of the month as they should, Stone again follows up with the family to straighten things out.

She's not sure who at the school will have time to do that next year.

"Some kids are on three different meds at lunchtime," Stone said. "How is a teacher going to do all that? The probability of mis-medication is going to be higher."

The reduction in the number of grant-funded nurses is likely to affect younger grades more than students in the larger high schools, which often have school-based clinics through Aurora Health Care or the Medical College of Wisconsin, said Riojas. She added that those clinics often offer more robust services, such as counseling, injury and illness services, and sports physicals.

But nurses for young children are important because they serve as impartial adults for children to confide in, Riojas said.

"On a daily basis, nurses call with referrals for child abuse and child neglect," she added. "It's because of that relationship that the student will feel safe and tell the nurse."

About Erin Richards

Erin Richards covers K-12 education in urban and suburban Milwaukee, as well as state politics related to education issues.